Ulcerative colitis (UC) is a chronic inflammatory disease of the colon, which is relatively common but remains poorly understood.

Diagnosis must be made by a healthcare practitioner—typically a gastroenterologist. Irritable bowel syndrome, a completely unrelated and less serious condition, was sometimes called mucous colitis in the past. As a result, the general term “colitis“ is still sometimes used inappropriately to refer to irritable bowel syndrome. It is critical that people who are diagnosed with “colitis” find out whether they have irritable bowel syndrome or UC.

For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms of UC?

UC is characterized by frequent abdominal pain and bloody diarrhea. Other symptoms may include fatigue, weight loss, decreased appetite, and nausea.

Dietary changes that may be helpful for ulcerative colitis

Some studies have shown that high sugar intake is associated with an increase in risk for UC.1 2 Other research has failed to find any association between UC and sugar intake.3 4 Until more is known, persons with inflammatory bowel diseases, including UC, should consider limiting their intake of sugar.

In two studies, people with a high intake of animal fat, cholesterol, or margarine had a significantly increased risk of UC, compared with people who consumed less of these fats.5 6 Although these associations do not prove cause-and-effect, reducing one’s intake of animal fats and margarine is a means of improving overall health and possibly UC as well.

There is preliminary evidence that people who eat fast food at least twice a week have nearly four times the risk of developing UC than people who do not eat fast food.7

More than a half-century ago, several doctors reported that food allergies play an important role in some cases of UC.8 9 Since that time, many doctors have observed that avoidance of allergenic foods will often reduce the severity of UC and can sometimes completely control the condition. In other old studies, milk has been reported to trigger UC,10 and people with UC were found to have antibodies to milk in their blood, a possible sign of allergy.11 Today the relationship between food allergies and UC remains controversial12 and is not generally accepted by the conventional medical community. People who wish to explore the possibility that food sensitivities may trigger their symptoms may wish to consult with an appropriate healthcare provider.

In a preliminary study, 39 patients with mild to moderate ulcerative colitis experienced significant improvement after receiving 30 grams (about 1 oz) per day of a germinated barley product for four weeks.13 Controlled trials are needed to confirm this report.

Lifestyle changes that may be helpful for ulcerative colitis

For unknown reasons, smokers have a lower risk of UC. The nicotine patch has actually been used to induce remissions in people with UC,14 although this treatment has been ineffective in preventing relapses.15 On the other hand, Crohn’s disease, which is in many ways similar to UC, is made worse by smoking.16 Despite the possible protective effect of smoking in people with UC, a strong case can be made that risks of smoking outweigh the benefits; even the use of nicotine patches carries its own side effects and remains experimental.

Nutritional supplements that may be helpful for ulcerative colitis

UC is linked to an increased risk of colon cancer. Studies have found that people with UC who take folic acid supplements or who have high blood levels of folic acid have a reduced risk of colon cancer compared with people who have UC and do not take folic acid supplements.17 18 19 Although these associations do not prove that folic acid was responsible for the reduction in risk, this vitamin has been shown to prevent experimentally induced colon cancer in animals.20 Moreover, low blood folic acid levels have been found in more than half of all people with UC.21 People with UC who are taking the drug sulfasalazine, which inhibits the absorption of folic acid,22 are at a particularly high risk of developing folic acid deficiency. Folic acid supplementation may therefore be important for many people with UC. Since taking folic acid may mask a vitamin B12 deficiency, however, people with UC who wish to take folic acid over the long term should have their vitamin B12 status assessed by a physician.

Alcohol consumption is known to promote folic acid deficiency and has also been linked to an increased risk of colon cancer.23 People with UC should, therefore, keep alcohol intake to a minimum.

Preliminary24 and double-blind trials25 26 27 have found that fish oil supplementation reduces inflammation, decreases the need for anti-inflammatory drugs, and promotes normal weight gain in people with UC. However, fish oil has not always been effective in clinical trials for UC.28 Amounts used in successful clinical trials provided 3.2 grams of EPA and 2.2 grams of DHA per day—the two important fatty acids found in fish oil.

A fatty acid called butyrate, which is synthesized by intestinal bacteria, serves as fuel for the cells that line the small intestine. Administration of butyrate by enema has produced marked improvement in people with UC in most,29 30 31 32 33 34 but not all,35 preliminary trials. Butyrate taken by mouth is not likely to be beneficial, as sufficient quantities do not reach the colon by this route. Although butyrate enemas are not widely available, they can be obtained by prescription through a compounding pharmacy, which prepares customized prescription medications to meet individual patient needs.

In preliminary36 and double-blind37 trials, a probiotic supplement (in this case, a non-disease-causing strain of Escherichia coli) was effective at maintaining remission in people with UC. In a double-blind trial, a combination probiotic supplement containing Lactobacilli, Bifidobacteria, and a beneficial strain of Streptococcus has been shown to prevent pouchitis, a common complication of surgery for UC.38 People with chronic relapsing pouchitis received either 3 grams per day of the supplement or placebo for nine months. Eighty-five percent of those who took the supplement had no further episodes of pouchitis during the nine-month trial, whereas 100% of those receiving placebo had relapses within four months. Preliminary evidence suggests that combination probiotic supplements may be effective at preventing UC relapses as well.39

In a preliminary trial, people with UC significantly improved on a sugar-free, low-allergen diet with additional nutritional supplementation that included a multivitamin-mineral supplement (2–6 tablets per day); a fish oil supplement (400 mg per day); borage oil (400 mg per day); flaxseed oil (400 mg per day); and a probiotic formula containing Lactobacillus acidophilus and other species of beneficial bacteria.40 Some participants received slight variations of this regimen. Since so many different supplements were given and since the trial was not controlled, it is not possible to say which, if any, of the nutrients was responsible for the improvement observed by the researchers.

Are there any side effects or interactions with ulcerative colitis?

Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful for ulcerative colitis

A small clinical study found that people with UC taking 550 mg of boswellia gum resin three times daily for six weeks had similar improvement in symptoms and the severity of their disease as people with UC taking the drug sulfasalazine.41 Overall, 82% of patients receiving boswellia, along with 75% of patients taking sulfasalazine, went into remission.

In a preliminary trial, people with UC remained in remission just as long when they took 20 grams of ground psyllium seeds twice daily with water as when they took the drug mesalamine.42 The combination of the two was slightly more effective than either alone. Controlled trials are now needed to confirm a therapeutic effect of psyllium for UC.

In a controlled trial, supplementation with wheat grass juice for one month resulted in clinical improvement in 78% of people with ulcerative colitis, compared with 30% of those receiving a placebo.43 The amount of wheat grass used was 20 ml per day initially; this was increased by 20 ml per day to a maximum of 100 ml per day (approximately 3.5 ounces).

German doctors practicing herbal medicine often recommend chamomile for people with colitis.44 A cup of strong tea drunk three times per day is standard, along with enemas using the tea when it reaches body temperature.

Enemas of oil of St. John’s wort may also be beneficial.45 Consult with a doctor before using St. John’s wort oil enemas.

Aloe vera juice has been used by some doctors for people with UC. Although aloe is known to have anti-inflammatory activity, it has not been studied specifically in people with UC. The same is true of other traditional anti-inflammatory and soothing herbs, including calendula, flaxseed, licorice, marshmallow, myrrh, and yarrow. Many of these herbs are most effective, according to clinical experience, if taken internally as well as in enema form.46 Enemas should be avoided during acute flare-ups but are useful for mild and chronic inflammation. It is best to consult with a doctor experienced with botanical medicine to learn more about herbal enemas before using them. More research needs to be done to determine the effectiveness of these herbs.

Are there any side effects or interactions with ulcerative colitis?

Refer to the individual herb for information about any side effects or interactions.

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